Pandemic (H1N1) 2009 and Hematologic Malignancy | CDC EID

EID Journal Home > Volume 16, Number 12–December 2010
Volume 16, Number 12–December 2010
Research
Pandemic (H1N1) 2009 Infection in Patients with Hematologic Malignancy


Catherine Liu, Comments to Author Brian S. Schwartz, Snigdha Vallabhaneni, Michael Nixon, Peter V. Chin-Hong, Steven A. Miller, Charles Chiu, Lloyd Damon, and W. Lawrence Drew
Author affiliation: University of California, San Francisco, California, USA

Suggested citation for this article

Abstract
To assess outcomes of patients with hematologic malignancy and pandemic (H1N1) 2009 infection, we reviewed cases during June–December 2009 at the University of California San Francisco Medical Center. Seventeen (63%) and 10 (37%) patients had upper respiratory tract infection (URTI) and lower respiratory tract infection (LRTI), respectively. Cough (85%) and fever (70%) were the most common signs; 19% of patients had nausea, vomiting, or diarrhea. Sixty-five percent of URTI patients were outpatients; 35% recovered without antiviral therapy. All LRTI patients were hospitalized; half required intensive care unit admission. Complications included acute respiratory distress syndrome, pneumomediastinum, myocarditis, and development of oseltamivir-resistant virus; 3 patients died. Of the 3 patients with nosocomial pandemic (H1N1) 2009, 2 died. Pandemic (H1N1) 2009 may cause serious illness in patients with hematologic malignancy, primarily those with LRTI. Rigorous infection control, improved techniques for diagnosing respiratory disease, and early antiviral therapy can prevent nosocomial transmission and optimize patient care.

Influenza is a major cause of illness and death in patients with hematologic malignancy and in hematopoietic cell transplant (HCT) recipients. In up to 30% of HCT recipients, illness progressed to lower respiratory tract infection (LRTI); death rates were 28% for patients in whom pneumonia developed (1). During spring 2009, infection caused by pandemic (H1N1) 2009 virus emerged in Mexico and spread rapidly throughout the world (2–4). Although it does not appear to be associated with higher death rates than seasonal influenza (5), pandemic (H1N1) 2009 virus has caused severe disease and death, particularly in persons with preexisting illnesses (6,7). Little is known about the clinical features and outcomes of pandemic (H1N1) 2009 infection in patients with hematologic malignancy. One recently published study suggested that pandemic (H1N1) 2009 causes mild disease in most patients with hematologic malignancy (8), but several reports have been published about patients with severe infection and respiratory failure (9–11). Risk factors for progression to LRTI are unknown. To characterize the clinical spectra and outcomes of pandemic (H1N1) 2009 disease in patients with hematologic malignancy, we reviewed the first 27 cases of pandemic (H1N1) 2009 among these patients in the University of California San Francisco Medical Center during June 1–December 31, 2009.

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Pandemic (H1N1) 2009 and Hematologic Malignancy | CDC EID


Suggested Citation for this Article

Liu C, Schwartz BS, Vallabhaneni S, Nixon M, Chin-Hong PV, Miller SA, et al. Pandemic (H1N1) 2009 infection in patients with hematologic malignancy. Emerg Infect Dis [serial on the Internet]. 2010 Dec [date cited]. http://www.cdc.gov/EID/content/16/1/1910.htm

DOI: 10.3201/eid1612.100772

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Catherine Liu, University of California, San Francisco, Division of Infectious Diseases, 513 Parnassus Ave S-380, San Francisco, CA 94143-0654, USA; email: catherine.liu@ucsf.edu